IMPLEMENTING CLINICAL RESEARCH IN THE HIGH ACUITY SETTING OF THE EMERGENCY DEPARTMENT

2.50
Hdl Handle:
http://hdl.handle.net/10755/211551
Type:
Research Study
Title:
IMPLEMENTING CLINICAL RESEARCH IN THE HIGH ACUITY SETTING OF THE EMERGENCY DEPARTMENT
Abstract:
Purpose/Aims: The aim of the parent study is to examine the influence of gender on symptom characteristics during acute coronary syndromes (ACS). Rationale/Conceptual Basis/Background: Emergency department (ED) visits are on the rise in the U.S., with 117 million visits in 2007. Eight million of those visits were for chest pain, and those numbers are increasing. Current standards call for rapid evaluation of chest pain patients, with several procedures required within the initial 5-10 minutes. Conducting research in this setting is challenging. Methods: Symptoms are recorded prospectively in the ED as they are occurring. The target is 630 patients admitted to the ED with symptoms suggestive of ACS: 522 patients with confirmed ACS and 108 patients ruled out for ACS. Patients are being enrolled in 4 urban EDs in California, Oregon, and Illinois with annual visits in excess of 200,000. The purpose of this report is to describe facilitators and barriers to implementing research in the highly acute ED setting. Results: The interdisciplinary research team is comprised of nurse scientists, emergency medicine physicians, statisticians, clinical research personnel, and students. Collaboration and communication have been critical to the successful launch of the study. Key facilitators to the success of enrollment to date are monthly interdisciplinary meetings, a strong infrastructure of research within the EDs, frequent communications among the team at all levels, acknowledgement that patient care always takes precedence over research, and identification of high risk patients for enrollment. Barriers to the study launch were differing cultures in each ED, lack of engagement from some staff, and role confusion. Implications: Several important lessons can aid other investigators conducting research in high acuity settings: 1) unit champions in nursing and medicine were identified and recruited; 2) specific written expectations, roles, research protocols, and algorithms were critical; 3) minor modifications that did not change study aims but could improve enrollment goals and maintain fidelity to protocols were made based on clinician input; 4) successes were shared between sites via e-mail, phone calls, and regularly scheduled meetings and; 5) being gracious and rewarding cooperation and success was key to overcoming barriers. Initiating rigorous clinical studies in the ED setting presents unique challenges but can be overcome through development of clear study algorithms and communication. Acknowledgement: This study is funded by NINR (1R01NR012012-01)
Keywords:
Symptoms; Coronary heart disease; Gender Differences
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
4652
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleIMPLEMENTING CLINICAL RESEARCH IN THE HIGH ACUITY SETTING OF THE EMERGENCY DEPARTMENTen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211551-
dc.description.abstractPurpose/Aims: The aim of the parent study is to examine the influence of gender on symptom characteristics during acute coronary syndromes (ACS). Rationale/Conceptual Basis/Background: Emergency department (ED) visits are on the rise in the U.S., with 117 million visits in 2007. Eight million of those visits were for chest pain, and those numbers are increasing. Current standards call for rapid evaluation of chest pain patients, with several procedures required within the initial 5-10 minutes. Conducting research in this setting is challenging. Methods: Symptoms are recorded prospectively in the ED as they are occurring. The target is 630 patients admitted to the ED with symptoms suggestive of ACS: 522 patients with confirmed ACS and 108 patients ruled out for ACS. Patients are being enrolled in 4 urban EDs in California, Oregon, and Illinois with annual visits in excess of 200,000. The purpose of this report is to describe facilitators and barriers to implementing research in the highly acute ED setting. Results: The interdisciplinary research team is comprised of nurse scientists, emergency medicine physicians, statisticians, clinical research personnel, and students. Collaboration and communication have been critical to the successful launch of the study. Key facilitators to the success of enrollment to date are monthly interdisciplinary meetings, a strong infrastructure of research within the EDs, frequent communications among the team at all levels, acknowledgement that patient care always takes precedence over research, and identification of high risk patients for enrollment. Barriers to the study launch were differing cultures in each ED, lack of engagement from some staff, and role confusion. Implications: Several important lessons can aid other investigators conducting research in high acuity settings: 1) unit champions in nursing and medicine were identified and recruited; 2) specific written expectations, roles, research protocols, and algorithms were critical; 3) minor modifications that did not change study aims but could improve enrollment goals and maintain fidelity to protocols were made based on clinician input; 4) successes were shared between sites via e-mail, phone calls, and regularly scheduled meetings and; 5) being gracious and rewarding cooperation and success was key to overcoming barriers. Initiating rigorous clinical studies in the ED setting presents unique challenges but can be overcome through development of clear study algorithms and communication. Acknowledgement: This study is funded by NINR (1R01NR012012-01)en_GB
dc.subjectSymptomsen_GB
dc.subjectCoronary heart diseaseen_GB
dc.subjectGender Differencesen_GB
dc.date.available2012-02-20T12:01:49Z-
dc.date.issued2012-02-20T12:01:49Z-
dc.date.accessioned2012-02-20T12:01:49Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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